Department: Leadership Q&A
Senior Vice President of Patient Care Services and Chief Nursing Officer, Lutheran Medical Center, Brooklyn, N.Y.
Q Some companies hire for talent, others hire only when there's an open position. What's the right answer?
There's no “right” answer to this question because every organization has different priorities, budget considerations, human resource practices, departmental needs, and leadership values. Even the definition of “talent” differs from organization to organization. I understand the viewpoint of wanting to hire an amazing prospective employee even when there's no open position—it's a treasure to have stars on our teams affecting positive outcomes in many ways.
Most organizations have an approval process to fill vacancies. Tight position control is one hallmark of effective personnel budget management, along with effective staffing and scheduling practices. I would be very surprised if you had an easy approval for a position that didn't exist.
So when is hiring for talent in the absence of an open position appropriate? For staff positions, an experienced specialty nurse whose enthusiasm and personality fit the unit would be an incredible asset. If you have no vacancies, over hiring for expected turnover or a float team may be a solution. For leadership positions, a skilled, “perfect-fit” candidate may be hired temporarily for project work or an area with high risk and need. It can buy some time for a position to open up or for the candidate to become such an essential part of the team that working without him or her is hard to imagine. You'd still have to justify the budget or reorganize to use another position for the hire. It's possible to make a budget neutral case if the candidate's ability for program development will result in expense reduction or added revenue.
Another different but related scenario is the multitude of new graduates who are having difficulty finding positions. What responsibility do we have to grow future nurses, especially when we know there will be tremendous need as baby boomers retire? Developing residencies and internships, adding float team positions to decrease overtime, creating additional positions by splitting full-time equivalents, and even crafting volunteer programs can chip away at this thorny issue. At the very least, hire talent for open positions!
Q We've seen an increase in I.V. infections. Is it time to bring back I.V. therapists?
I wouldn't jump to conclusions so quickly. There could be many reasons for an increase in infections and just as many solutions. Take a deep dive into the root cause or causes of the issue, as well as what the evidence says in terms of interventions. I.V. therapy, although basic to patient care, is full of risk if evidence-based practices aren't followed at all times.
Where are the infections occurring? Is it clustered in an area or widespread? Are they related to insertion or maintenance? Who's starting the I.V.s—nurses, residents, house staff members—and are their I.V. competencies validated? Are your procedures up-to-date with the latest evidence? Are they followed? Are all the supplies needed for both insertion and maintenance readily available? Is staffing adequate for the volume and acuity or are you at risk for workarounds to save time when staff members are rushed and stressed? These are just some of the variables to be assessed to find the appropriate corrective action plan for your organization.
The Infusion Nurses Society is a well-established professional organization with many resources, such as standards, policies and procedures, competencies, texts, and newsletters, on its website. As one of your first steps, make a solid assessment of how actual practice compares with the most current evidence-based standards, including user input. You'll also want to research the outcomes of I.V. teams.
Bringing issues to staff members for problem solving is a great approach—they have the best ideas and solutions that work in the real world. Between the gap analysis, staffing assessment, infection investigation, and user input, you'll most likely have a lot of opportunity for improvement before moving the responsibility to I.V. therapists, never mind the budget justification you'd have to create. Even in the best of worlds, an I.V. team won't be able to handle insertion and maintenance 100% of the time, so it's important to look at other approaches to quality improvement. There may also be a place for a specialized team with a limited scope of responsibility in your problem areas.